In the wake of past mass shootings, when the “national conversation” has focused exclusively on guns, I have argued that our appallingly inadequate mental health system was a better subject of reform. At least half of the shooters in the rampage killings that are ripping our hearts out are young men with serious mental illnesses, and our system has neither the legal nor the financial resources to get them the treatment and/or restraint that they, and we, desperately need.

This time, mental health reform has received passing mention, along with the usual pleas for gun control, better security at schools, and so forth.

Some control of ammunition might be useful at the margins (though the Connecticut killer seems to have obtained his deadly arsenal from his mother). As for security, some have argued that placing armed officials in schools would profoundly alter the tenor of American life.

I can report that in Fairfax County, Va., where my children attend public schools, every middle and high school has an armed police officer on duty every day. It doesn’t feel like a prison camp. It’s somewhat reassuring.

Modesty is called for in judging what causes these mass killings in America and elsewhere (Australia, Norway and China have also experienced them). Guns have always been readily available in this country, yet these random massacres in classrooms or malls or movie theaters full of innocent strangers are new. Is it the dissolution of families? The decline of religious faith? The fading of civil institutions, such as churches and community groups? Is popular culture to blame? Is it the wall-to-wall coverage?

It’s worth considering all of the above. These are the acts of profoundly disturbed or insane individuals, yes, but culture affects the way even the mentally unbalanced behave. The rate of violent crime has been declining for more than a decade, which suggests that we are not in grip of mass depravity. But if we believe great works have the capacity to ennoble, we must concede that vile works can corrupt.

Mass shooting has become an American form of psychosis — with each new horror inviting an even more grotesque imitator.

Mental illness takes different forms in different times and places. Before American culture became obsessed with thinness as a standard of beauty, anorexia nervosa was exceedingly rare. In Japan, a culture that prizes social cohesion, people suffer from taijin kyofusho, an extreme fear of offending other people through body odor or appearance. In Malaysia, Scientific American reports, an illness called “amok” (from which comes the expression “running amok”) periodically afflicts young men. They respond to perceived slights with a brooding withdrawal, followed by explosions of violence. In Greenland, some seal hunters get a syndrome called “kayak angst” featuring intense panic while out on the ocean.

With our splintering families, declining participation in civil society and greater alienation, we are nonetheless entertaining ourselves with an endless stream of depraved violence and sexuality. Many kids are not having a family dinner with mom and dad every night, but instead are closeted hour after hour with a shooting game on Xbox. No one is watching with them to offer commentary or perspective.

Violence and sex have, obviously, always been with us. Hamlet has its violent moments. Yet the violence of great literature, or even of ordinary melodrama, was usually presented within a moral context. It was nearly always the case that heroic figures used violence to thwart evil, not for the fun of it.

Some filmmakers scoffed at the “antiseptic” violence of the old Westerns in which the bad guys would take a bloodless bullet, cry “Ah, you got me,” and fall from their horses. Far better, it was argued, to show a simulacrum of the real thing.

But viewing realistic violence and suffering, far from repelling or sensitizing people, has the capacity to inure us to the horror, dull our capacity for compassion and coarsen our sensibilities. Worse, for a subset of unbalanced viewers, graphic violence is perversely pleasurable. It may also be disinhibiting. The Columbine killers were great fans of the movie Natural Born Killers.

It will require tremendous effort, time and resources to repair our mental health system. But it would be a simple matter of will for entertainers to ask themselves, before marketing a violence-soaked film or game: “How will this affect the mentally unstable?”

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